Relationship between breast arterial calcification on mammography with coronary CT angiography findings

Abstract

BACKGROUND: Breast arterial calcification is a frequently benign finding on mammography that usually is not reported. An increasing attention has been formed to determine the association between breast arterial calcification (BAC) and Coronary artery disease. In the current study we have aimed to evaluate the relationship between BAC on mammography with coronary CT angiography findings.

METHODS: The case control study was carried out on 60 women; 30 CAD and 30 healthy subjects as control, admitted to Golestan hospital radiology department. The mammography was performed in two views; Craniocaudal (CC) view and mediolateral oblique (MLO) and BAC was graded based on the severity and extent of calcifications. Coronary Arterial Calcification (CAC) were scored by Agatston criteria.

RESULTS: Overly, 36 patients (60%) were positive for BAC. Twenty six out of them (72%) were CAD. There was a positive significant correlation between BAC and CAD. The sensitivity and specificity of BAC for CAD were 69% and 47%, respectively. Moreover, the severe BAC scores were significantly higher in CAD patients than non-CAD.

CONCLUSION: Our findings in line with several previous studies indicated the positive significant association between BAC and CAD occurrence. While the sensitivity and specificity of BAC in diagnosis of CAD is low, suggested the using of BAC just as a CAD risk factor. The relatively low sample size is the major limitation of the study.

Key words： breast arterial calcification; CAD; angiography

Acknowledgments

We wish to thank all our colleagues in Imam Khomeini Hospital, Ahvaz, Iran.

Compliance with ethical standards

The authors declared no conflict of interest. All procedures have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was signed prior to participation in the study.

References

1 Abi Rafeh N, Castellanos M R, Khoueiry G, Meghani M, El-Sayegh S, Wetz R V, Lafferty J C, Kleiner M, Tamburrino F, Kiss A, Raia C, Kowalski M (2012). Association between coronary artery disease diagnosed by coronary angiography and breast arterial calcifications on mammography: meta-analysis of the data. J Womens Health (Larchmt), 21(10): 1053–1058

PMID

2 Akhabue E, Thiboutot J, Cheng J W, Vittorio T J, Christodoulidis G, Grady K M, Lerakis S, Kosmas C E (2014). New and emerging risk factors for coronary heart disease. Am J Med Sci, 347(2): 151–158

PMID

3 Akinola R A, Ogbera O A, Onakoya J A, Enabulele C E, Fadeyibi I O (2011). Mammograms and breast arterial calcifications: looking beyond breast cancer: a preliminary report. BMC Res Notes, 4(1): 207

PMID

4 Arleo E K, Hendrick R E, Helvie M A, Sickles E A (2017). Comparison of recommendations for screening mammography using CISNET models. Cancer, 123(19): 3673–3680

PMID

5 Becker C R, Kleffel T, Crispin A, Knez A, Young J, Schoepf U J, Haberl R, Reiser M F (2001). Coronary artery calcium measurement: agreement of multirow detector and electron beam CT. AJR Am J Roentgenol, 176(5): 1295–1298

PMID

6 Chadashvili T, Litmanovich D, Hall F, Slanetz P J (2016). Do breast arterial calcifications on mammography predict elevated risk of coronary artery disease? Eur J Radiol, 85(6): 1121–1124

PMID

7 Crystal P, Zelingher J, Crystal E (2004). Breast arterial calcifications as a cardiovascular risk marker in women. Expert Rev Cardiovasc Ther, 2(5): 753–760

PMID

8 Hendriks E J, de Jong P A, van der Graaf Y, Mali W P, van der Schouw Y T, Beulens J W (2015). Breast arterial calcifications: a systematic review and meta-analysis of their determinants and their association with cardiovascular events. Atherosclerosis, 239(1): 11–20

PMID

9 Henkin Y, Abu-Ful A, Shai I, Crystal P (2003). Lack of association between breast artery calcification seen on mammography and coronary artery disease on angiography. J Med Screen, 10(3): 139–142

PMID

10 Kandaswamy E, Zuo L (2018). Recent Advances in Treatment of Coronary Artery Disease: Role of Science and Technology. Int J Mol Sci, 19(2): 424

PMID

11 Kim H, Greenberg J S, Javitt M C (1999). Breast calcifications due to Mönckeberg medial calcific sclerosis. Radiographics, 19(5): 1401–1403

PMID

12 McEvoy J W, Blaha M J, Defilippis A P, Budoff M J, Nasir K, Blumenthal R S, Jones S R (2010). Coronary artery calcium progression: an important clinical measurement? A review of published reports. J Am Coll Cardiol, 56(20): 1613–1622

PMID

13 McEvoy J W, Blaha M J, Defilippis A P, Budoff M J, Nasir K, Blumenthal R S, Jones S R (2010). Coronary artery calcium progression: an important clinical measurement? A review of published reports. J Am Coll Cardiol, 56(20): 1613–1622

PMID

14 Mostafavi L, Marfori W, Arellano C, Tognolini A, Speier W, Adibi A, Ruehm S G (2015). Prevalence of coronary artery disease evaluated by coronary CT angiography in women with mammographically detected breast arterial calcifications. PLoS One, 10(4): e0122289

PMID

15 Pletcher M J, Tice J A, Pignone M, Browner W S (2004). Using the coronary artery calcium score to predict coronary heart disease events: a systematic review and meta-analysis. Arch Intern Med, 164(12): 1285–1292

PMID

16 Polonsky T S, Greenland P (2017). Breast arterial calcification: expanding the reach of cardiovascular prevention. Circulation, 135(6): 499–501

PMID

17 Polonsky T S, McClelland R L, Jorgensen N W, Bild D E, Burke G L, Guerci A D, Greenland P (2010). Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA, 303(16): 1610–1616

PMID

18 Reddy J, Son H, Smith S J, Paultre F, Mosca L (2005). Prevalence of breast arterial calcifications in an ethnically diverse population of women. Ann Epidemiol, 15(5): 344–350

PMID

19 Rotter M A, Schnatz P F, Currier A A Jr, O’Sullivan D M (2008). Breast arterial calcifications (BACs) found on screening mammography and their association with cardiovascular disease. Menopause, 15(2): 276–281

PMID

20 Shirzadi S, Nadrian H, Asghari Jafarabadi M, Allahverdipour H, Hassankhani H (2017). Determinants of mammography adoption among iranian women: What are the differences in the cognitive factors by the stages of test adoption? Health Care Women Int, 38(9): 956–970

PMID

21 Talaei M, Sarrafzadegan N, Sadeghi M, Oveisgharan S, Marshall T, Thomas G N, Iranipour R (2013). Incidence of cardiovascular diseases in an Iranian population: the Isfahan Cohort Study. Arch Iran Med, 16(3): 138–144

PMID

22 Topal U, Kaderli A, Topal N B, Özdemir B, Yeşilbursa D, Cordan J, Ediz B, Aydinlar A (2007). Relationship between the arterial calcification detected in mammography and coronary artery disease. Eur J Radiol, 63(3): 391–395

PMID

23 Yildiz S, Toprak H, Aydin S, Bilgin M, Oktay V, Abaci O, Kocas C (2014). The association of breast arterial calcification and metabolic syndrome. Clinics (Sao Paulo), 69(12): 841–846

PMID

24 Zeb I, Budoff M (2015). Coronary artery calcium screening: does it perform better than other cardiovascular risk stratification tools? Int J Mol Sci, 16(3): 6606–6620

PMID

25 Zgheib M H, Buchbinder S S, Abi Rafeh N, Elya M, Raia C, Ahern K, Smith M C, Costantino T, Flory M J, Lafferty J C, Castellanos M R (2010). Breast arterial calcifications on mammograms do not predict coronary heart disease at coronary angiography. Radiology, 254(2): 367–373

PMID